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Interventions to reduce gender-based violence among young people living with or affected by HIV/AIDS in low- and middle- income countries

Meinck, Franziskaa,b,c; Pantelic, Marijaa,d; Spreckelsen, Thees F.a; Orza, Luisad; Little, Madison T.a; Nittas, Vasileiose; Picker, Vanessaa; Bustamam, Amy A.f; Romero, Rocio Herreroa; Mella, Eric P. Diazg; Stöckl, Heidih

doi: 10.1097/QAD.0000000000002337
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Objective(s): This study explored the effectiveness of gender-based violence (GBV) interventions on young people living with or affected by HIV in low- and middle-income countries (LMICs).

Design: Systematic review and meta-analysis.

Methods: We pre-registered a protocol, then searched thirteen databases and grey literature. We screened randomised and quasi-experimental studies (n = 2199) of young people (aged 10–24) living with or affected by HIV in LMICs. Outcomes were GBV and/or GBV-related attitudes. We appraised the data for risk of bias and quality of evidence. Narrative syntheses and multi-level random effects meta-analyses were conducted.

Results: We included 18 studies evaluating 21 interventions. Intervention arms were categorised as: a) sexual health and social empowerment (SHSE) (n = 7); b) SHSE plus economic strengthening (n = 4); c) self-defence (n = 3); d) safer schools (n = 2); e) economic strengthening only (n = 2); f) GBV sensitisation (n = 2) and g) safer schools plus parenting (n = 1). Risk of bias was moderate/high and quality of evidence low. Narrative syntheses indicated promising effects on GBV exposure, but no or mixed effects on GBV perpetration and attitudes for self-defence and GBV sensitisation interventions. Safer schools interventions showed no effects. For SHSE interventions and SHSE plus economic strengthening, meta-analysis showed a small reduction in GBV exposure but not perpetration. Economic-only interventions had no overall effect.

Conclusions: SHSE, SHSE plus and self-defence and gender sensitisation interventions may be effective for GBV exposure and GBV-related attitudes but not for GBV perpetration. However, the quality of evidence is poor. Future intervention research must include both boys and girls, adolescents living with HIV and key populations.

aDepartment of Social Policy & Intervention, University of Oxford, United Kingdom

bOptentia, Faculty of Health Sciences, North-West University, South Africa

cSchool of Social and Political Sciences, University of Edinburgh, United Kingdom

dFrontline AIDS, Brighton, United Kingdom

eEpidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland

fDepartment of Health Research Methods, Evidence and Impact, McMaster University, Canada

gEscuela de Psicología, Universidad Santo Tomas, Chile

hDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom.

Correspondence to Franziska Meinck, Department of Social Policy and Intervention, Oxford University, Oxford, OX1 2ER. E-mail: Franziska.Meinck@spi.ox.ac.uk

Received 13 March, 2019

Revised 3 July, 2019

Accepted 5 July, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.